Healthcare Provider Details

I. General information

NPI: 1285567065
Provider Name (Legal Business Name): STEVI SPENCER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 PLEASANT RUN STE A
SPRINGFIELD IL
62711-6334
US

IV. Provider business mailing address

16 COVERED BRIDGE ACRES
GLENARM IL
62536-6528
US

V. Phone/Fax

Practice location:
  • Phone: 309-431-2111
  • Fax:
Mailing address:
  • Phone: 309-922-7105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178.032761
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: